My Face Is Really Bothering Me

Question 1

What is acne?

Answer 1

Lesions develop from sebaceous glands

Sebaceous glands contain holocrine cells that secrete triglycerides, fatty acids, wax esters, sterols as sebum

Question 2

Main changes in acne

Answer 2

1. Thickening of keratin lining and obstruction of ducts (open ‘blackheads’ and closed ‘whiteheads comedones).

Oxidised melanin makes blackheads black.

2. Increase in sebum production
3. Increase in propionbacterium acnes bacteria within duct
4. Inflammation around the sebaceous gland, probably as a result of the release of bacterial enzymes

Question 3

Types of Acne (4)

Answer 3

Acne vulgaris - most common
Acne excoriée - patient picks @ skin creating disfiguring erosions
Infantile acne - first few months of life, may last 5 years
Acne conglobata/fulminans - more common in boys and tropical climate, extensive nodulocystic acne and abscess formation affecting trunk, face and limbs.

Question 4

Treatment for acne

Answer 4

Mild acne - cleansers (can cause dryness and scaling of the skin)

Topical treatments

• benzoyl peroxide (may get mild irritant dermatitis)
• salicylic acid (promotes desquamation of the follicular epitheleum - inhibits formation of comedones)
• Azelaic acid
• topical retinoids (vitamin A derivatives)
• topical antibiotics (erythromycin or clindamycin)

Question 5

First line treatment for acne

Answer 5

Topical retinoid (tretinoin)
Azelaic acid
Salicylic acid

Benzoyl peroxide

Topical retinoid +/- topical antibiotic +/- benzoyl peroxide

Question 6

Features of Rosacea

Answer 6

Facial flushing 
Persistent erythema
Telangiectasia
Inflammatory papules
Pustules 
Oedema

Rhinophyma
Conjunctivitis, blepharitis and eyelid oedema

Question 7

Questions to ask in an acne history

Answer 7

Age of onset and duration
Exacerbating factors (menstruation, anabolic steroids)
Prior and current treatment
PMH (obesity, menstrual irregularities [polycystic ovarian syndrome])
DH (topical and systemic steroids)
Effects of social life, work

Question 8

Differential diagnosis in acne

Answer 8

Rosacea (no comedones)
Seborrhoeic eczema (no pustules)
SLE (light sensitivity, erythema, scarring but no pustules)
Perioral dermatitis (women)

Question 9

Tool assessing psychosocial impact of acne

Tool assessing severity of acne

Answer 9

Assessment of the Psychological and Social Effects of Acne (APSEA)

Leeds scale (0-10)